A Cross-Sectional Study of Sports Food Consumption Patterns, Experiences, and Perceptions amongst Non-Athletes in Australia.

Sports foods are designed for athletes, yet their availability, type, and sales have increased over the past decade, likely driven by non-athlete use. This could lead to detrimental health outcomes via over/misuse or unwanted side effects. The aim of this study was to describe sports food consumption patterns and associated drivers, consumption reasons, perception of risks, and side effects experienced amongst non-athletes in Australia. In 2022, n = 307 non-athlete Australian adults (18-65 years) completed an online cross-sectional survey including closed-ended (consumption patterns, factors, and exercise participation) and open-ended questions (reasons for consumption, risk perception, and side effects experienced). Descriptive statistics (frequency and percent) described the sample. Ordinal logistic regression was used for univariate associations and a multivariate model was used to determine relationships between sports food consumption proxy and significant univariate associations. The themes were analysed via inductive thematic analysis using NVivo 14. Females consumed sports foods most frequently, 65% of participants consumed three or more sports foods, and participants with higher sports food consumption/frequency were less likely to perceive risks or experience side effects. The main reason for consumption was protein intake, digestion/stomach issues were the main perceived risks, and the main side effect was bloating. Despite understanding the risks and side effects, non-athlete consumers continue to use numerous sports foods, which appear to be influenced by sociodemographic factors and packaging labels. Tighter regulation of packaging-label information would ensure safer and more informed consumption.

Perseverance, partnerships and passion: ingredients for successful local government policy to promote healthy and sustainable diets.

BACKGROUND: Local government authorities are well-placed to invest in evidence-based food policies that promote a population-wide shift to healthy and sustainable diets. This study describes the contextual factors that facilitated or impeded policy-making related to healthy and sustainable diets within a 'best-performing' local government in Victoria, Australia. METHODS: Guided by the Consolidated Framework for Implementation Research (CFIR), data from semi-structured interviews with individuals involved in developing the City of Greater Bendigo's Food System Strategy were analysed using the seven-stage Framework Method. RESULTS: Semi-structured interviews (n = 24) were conducted with City of Greater Bendigo employees (n = 15) and key stakeholders working for local organisations (n = 6) or at a state or national level (n = 3). Interviewees mostly held positions of leadership (n = 20) and represented diverse areas of focus from health (n = 7), food systems (n = 4) and planning and public policy (n = 3). Data analysis revealed 12 cross-cutting themes; eight facilitating factors and four impeding factors. Facilitating factors included perseverance, community engagement, supportive state policy, effective leadership, a global platform and networks, partnerships, workforce capacity and passion, and the use of scientific evidence. Impeding factors included access to secure, ongoing financial resources, prohibitive state and federal policy, COVID-related disruptions to community engagement and competing stakeholder interests. Overall, this study suggests that the City of Greater Bendigo's success in developing an evidence-based local food system policy is built upon (i) a holistic worldview that embraces systems-thinking and credible frameworks, (ii) a sustained commitment and investment throughout the inner-setting over time, and (iii) the ability to establish and nurture meaningful partnerships with community groups, neighbouring local government areas and state-level stakeholders, built upon values of reciprocity and respect. CONCLUSIONS: Despite insufficient resourcing and prohibitive policy at higher levels of government, this 'best performing' local government in Victoria, Australia developed an evidence-based food system policy by employing highly skilled and passionate employees, embracing a holistic worldview towards planetary health and harnessing global networks. Local government authorities aspiring to develop integrated food policy should nurture a workforce culture of taking bold evidence-informed policy action, invest in mechanisms to enable long-standing partnerships with community stakeholders and be prepared to endure a 'slow-burn' approach.

Local government policy to facilitate healthy and sustainable diets and the broader policy hierarchy: insights from Milan Urban Food Policy Pact cities.

BACKGROUND: Local government authorities are well positioned to change the way food is produced and consumed through the implementation of integrated food policies. By facilitating the uptake of healthy and sustainable diet-related practices, integrated local government food policy can trigger change throughout the food supply chain. This study aimed to provide insights as to how the policy hierarchy surrounding local governments may be influencing local government's capacity to create integrated food policy. METHODS: Content analysis was conducted on local government food policies (n = 36) from signatory cities of the Milan Urban Food Policy Pact were mapped to seven global regions. A set of 13 predetermined healthy and sustainable diet-related practices, organized into three categories: "where to source food", "what to eat" and "how to eat", was used to assess the level of integration of each local government food policy. Additional policies from the broader policy hierarchy that were mentioned in each local government food policy were sourced and then screened for relevancy, charted according to their level of administration (local, national, global region, international) and analysed to consider which diet-related practice(s) each broader policy was likely to promote. RESULTS: Analysis revealed three key insights: (i) local government food policies across all included global regions (n = 4) mostly promoted practices in the "where to source food" category, (ii) local government food policies across all global regions referred to policies from higher levels of administration (local, national, global region and international) which tended to also promote practices in the "where to source food" category and (iii) regarding the level of integration, local government food policies in Europe and Central Asia targeted the highest number of diet-related practices. CONCLUSIONS: The level of integration of food policy at national, global region and international levels may be influencing that of local governments. Further research is required to understand why local government food policies are referring to some relevant policies and not others, and to determine whether a greater focus on the diet-related practices of "what to eat" and "how to eat" in policies from higher levels of government would support local governments to also prioritize these practices in their food policies.

Sports foods are not all they shake up to be. An audit of formulated supplementary sports food products and packaging in Australian retail environments.

Objective: To determine store availability, total number of products, and types of Formulated Supplementary Sports Foods in Australia, along with their stated nutrition content, sweeteners added, total number, and type of claims displayed on the packaging. Design: A cross-sectional, visual product audit of mainstream retailers. Setting: Supermarkets, pharmacies, health food stores, and gym/fitness centres. Results: A total of 558 products were captured in the audit, 275 of which displayed the correct mandatory packaging attributes. Three categories of products were identified, based on the dominant nutrient. Only 184 products appeared to display the correct energy value based on the listed macronutrient content (protein, fat, carbohydrate, dietary fibre). The stated nutrient content was highly variable across all product subcategories. Nineteen different sweeteners were identified, with most foods containing only one (38.2%) or two (34.9%) types. The predominant sweetener was stevia glycosides. Packages displayed multiple claims, with a maximum of 67 and minimum of 2 claims. Nutrition content claims were most frequently displayed (on 98.5% of products). Claims included regulated, minimally regulated and marketing statements. Conclusion: Sports food consumers should be provided with accurate and detailed on pack nutrition information, to ensure informed choices are made. However, this audit showed multiple products which did not conform to current standards, appeared to provide inaccurate nutrition information, contained multiple sweeteners, and displayed an overwhelming number of on-pack claims. The increase in sales, availability, and products available in mainstream retail environments, could be impacting both intended consumers (athletes), and general non-athlete population. The results indicate underperformance in manufacturing practices which preference marketing over quality and stronger regulatory approaches are needed to protect consumer health and safety, and to prevent misleading consumers.

Ultra-processed food consumption, socio-demographics and diet quality in Australian adults.

OBJECTIVE: To examine how socio-demographic characteristics and diet quality vary with consumption of ultra-processed foods (UPF) in a cross-sectional nationally representative survey of Australian adults. DESIGN: Using a 24-h recall, this cross-sectional analysis of dietary and socio-demographic data classified food items using the NOVA system, estimated the percentage of total energy contributed by UPFs and assessed diet quality using the Dietary Guideline Index (DGI-2013 total and components). Linear regression models examined associations between socio-demographic characteristics and diet quality with percentage of energy from UPF. SETTING: Australian Health Survey 2011-2013. PARTICIPANTS: Australian adults aged ≥ 19 years (n 8209). RESULTS: Consumption of UPF was higher among younger adults (aged 19-30 years), adults born in Australia, those experiencing greatest area-level disadvantage, lower levels of education and the second lowest household income quintile. No significant association was found for sex or rurality. A higher percentage of energy from UPF was inversely associated with diet quality and with lower DGI scores related to the variety of nutritious foods, fruits, vegetables, total cereals, meat and poultry, fish, eggs, nuts and seeds, legumes/beans, water and limits on discretionary foods, saturated fat and added sugar. CONCLUSIONS: This research adds to the evidence on dietary inequalities across Australia and how UPF are detrimental to diet quality. The findings can be used to inform interventions to reduce UPF consumption and improve diet quality.

The Nutritional Profile and On-Pack Marketing of Toddler-Specific Food Products Launched in Australia between 1996 and 2020.

With the food system evolving, it is not clear how the nutrition and on-pack claims of toddler foods have been impacted. Data on the trends in Australia are lacking, so we sought to determine the changes in the nutrition and on-pack claims of toddler-specific packaged foods over time. A retrospective cross-sectional analysis was conducted using the Mintel Global New Products Database. The number of toddler-specific foods increased from 1996 to 2020. Over time, a lower proportion of meals and snacks were classified as "ultra-processed", but a higher proportion of snacks were classified as "discretionary". Meals launched after 2014 had higher median values for energy, saturated fat, and sugar than those in earlier years. Toddler snacks launched after 2014 had lower median values for sodium, and higher median values for fat, saturated fat, and sugar than those in earlier years. The mean number of total claims per package increased over time for snacks, with an increase in unregulated claims for both meals and snacks. Public health action is needed to ensure that the retail food environment for young children is health-promoting, including stringent and clear regulations for on-pack claims, and compositional guidelines and guidance on how to reduce the number of ultra-processed foods for toddlers.

Nutrition and packaging characteristics of toddler foods and milks in Australia.

OBJECTIVE: To analyse nutritional and packaging characteristics of toddler-specific foods and milks in the Australian retail food environment to identify how such products fit within the Australian Dietary Guidelines (ADG) and the NOVA classification. DESIGN: Cross-sectional retail audit of toddler foods and milks. On-pack product attributes were recorded. Products were categorised as (1) food or milk; (2) snack food or meal and (3) snacks sub-categorised depending on main ingredients. Products were classified as a discretionary or core food as per the ADG and level of processing according to NOVA classification. SETTING: Supermarkets and pharmacies in Australia. RESULTS: A total of 154 foods and thirty-two milks were identified. Eighty percentage of foods were snacks, and 60 % of foods were classified as core foods, while 85 % were ultraprocessed (UP). Per 100 g, discretionary foods provided significantly more energy, protein, total and saturated fat, carbohydrate, total sugar and Na (P < 0·001) than core foods. Total sugars were significantly higher (P < 0·001) and Na significantly lower (P < 0·001) in minimally processed foods than in UP foods. All toddler milks (n 32) were found to have higher energy, carbohydrate and total sugar levels than full-fat cow's milk per 100 ml. Claims and messages were present on 99 % of foods and all milks. CONCLUSIONS: The majority of toddler foods available in Australia are UP snack foods and do not align with the ADG. Toddler milks, despite being UP, do align with the ADG. A strengthened regulatory approach may address this issue.

Energy Density of New Food Products Targeted to Children.

High dietary energy density (ED) is linked to childhood obesity and poor diet quality. The Australian Health Star Rating (HSR) system aims to assist consumers in making healthful food choices. This cross-sectional study used 2014-2018 data from the Mintel Global New Products Database to describe the ED of new food products targeted to children (5-12 years) released after the introduction of HSR and examine relationships between ED and HSR. Products were categorised by ED (low < 630 kJ/100 g, medium 630-950 kJ/100 g, high > 950 kJ/100 g) and HSR (no, HSR < 2.5 low, HSR ≥ 2.5 high). Non-parametric statistics were used to examine ED and HSR. A total of 548 products targeted children: 21% low, 5% medium, 74% high ED. One hundred products displayed an HSR: 24% low, 76% high; 53 products with both high HSR and ED. The EDs of products differed by HSR (p < 0.05), but both group's medians (HSR < 2.5: 1850 kJ/100 g, HSR ≥ 2.5: 1507 kJ/100 g) were high. A high proportion of new products had a high ED, and the HSR of these foods did not consistently discriminate between ED levels, particularly for high ED foods. Policies to promote lower ED foods and better alignment between ED and HSR may improve childhood obesity and diet quality.

Evaluating Nutrient-Based Indices against Food- and Diet-Based Indices to Assess the Health Potential of Foods: How Does the Australian Health Star Rating System Perform after Five Years?

Nutrient-based indices are commonly used to assess the health potential of individual foods for nutrition policy actions. This study aimed to evaluate the nutrient profile-informed Australian Health Star Rating (HSR), against NOVA and an index informed by the Australian Dietary Guidelines (ADGs), to determine the extent of alignment. All products displaying an HSR label in the Australian marketplace between June 2014 and June 2019 were extracted from the Mintel Global New Product Database, and classified into one of four NOVA categories, and either as an ADG five food group (FFG) food or discretionary food. Of 4451 products analysed, 76.5% were ultra-processed (UP) and 43% were discretionary. The median HSR of non-UP foods (4) was significantly higher than UP foods (3.5) (p < 0.01), and the median HSR of FFG foods (4) was significantly higher than discretionary foods (2.5) (p < 0.01). However, 73% of UP foods, and 52.8% of discretionary foods displayed an HSR ≥ 2.5. Results indicate the currently implemented HSR system is inadvertently providing a 'health halo' for almost ¾ of UP foods and ½ of discretionary foods displaying an HSR. Future research should investigate whether the HSR scheme can be reformed to avoid misalignment with food-and diet-based indices.

The Health Star Rating system - is its reductionist (nutrient) approach a benefit or risk for tackling dietary risk factors?

The Australian Government's voluntary Health Star Rating (HSR) system has potential to provide a user-friendly approach to help shoppers choose healthier packaged food options. However, despite evidence that it is dietary imbalances and excesses that are the predominant causes of diet-related noncommunicable diseases and obesity, the star-rating system's design is based on a reductionist (nutrient) world view of nutrition science which is not a fit-for-purpose solution to the cause of the problem. As a result, the HSR system frequently is inadvertently contradicting Australian Dietary Guidelines (ADG) recommendations, and promoting the marketing of discretionary and ultraprocessed foods. This perspective article looks at how the HSR system could be reformed to complement the ADG and stresses the overriding priority is to position it within, and not be a distraction from, a comprehensive national nutrition policy if dietary risk factors are to be effectively tackled.

Analysing the use of the Australian Health Star Rating system by level of food processing.

BACKGROUND: The consumption of ultra-processed foods is associated with diminished dietary quality and adverse health outcomes. The Australian Health Star Rating (HSR) is a nutrient-based front-of-pack (FOP) labelling system that assesses the 'healthiness' of foods on a scale of 0.5 to 5 stars based on their content of 'risk' and 'positive' nutrients. This study aimed to analyse the use of health stars on new packaged food products entering the Australian marketplace by level of food processing. METHODS: The Mintel Global New Product Database (GNPD) was searched to identify the number of stars displayed on the labels of all new packaged food products participating in the HSR system released into the Australian retail food supply between 27 June 2014 (the endorsement date) and 30 June 2017. Products were categorised by the four NOVA food processing categories: unprocessed and minimally processed (MP), processed culinary ingredients (PCI), processed (P), and ultra-processed (UP), and the distribution of the star ratings within each category was compared and analysed. RESULTS: The majority of new food products displaying an HSR were UP (74.4%), followed by MP (12.5%), P (11.6%), and PCI (1.5%). The median HSR of MP products (4.5) was significantly higher than the median of P (4) and UP products (3.5) (all p < 0.05). In all NOVA categories HSR profiles were distributed towards higher star ratings, and the majority (77%) of UP products displayed an HSR ≥ 2.5. CONCLUSIONS: The HSR is being displayed on a substantial proportion of newly released UP foods. Technical weaknesses, design flaws and governance limitations with the HSR system are resulting in 3 out of 4 instances of these UP foods displaying at least 2.5 so-called 'health' stars. These findings add further evidence to concerns that the HSR system, in its current form, is misrepresenting the healthiness of new packaged food products and creating a risk for behavioural nutrition.

Vegetables and legumes in new Australasian food launches: how are they being used and are they a healthy choice?

BACKGROUND: Despite the health benefits of regular vegetable and legume consumption, on average Australians are consuming only half of the recommended daily intake. The reasons for this low consumption are complex, and are particularly driven by societal shifts towards convenient and ready-to-eat meal options. It is currently unknown how legumes and vegetables are being utilised in food products within the Australian context, and the nutritional value or level of processing of these products. METHODS: The Mintel Global New Food Database was used to identify all new products launched between May 2012 and May 2017 in Australasia which at least 0.5 serves of vegetables and/or legumes per recommended serving. Eligible products were coded using the NOVA food classification system and the Healthy Choices guidelines, and were categorized by the researchers based on the type and proportion of vegetable and legume ingredients used. RESULTS: Overall, 1313 products were identified, which contained a median of 55% vegetable and legume ingredients (IQR = 45%). This translated to approximately 1 (IQR = 1) serves of vegetables and legumes per recommended serving of the products. The product launches were most likely to be classified as an 'amber' choice, and be classified as either 'processed' or 'ultra-processed'. Vegetables and legumes were mainly found in the form of new prepared meals, soups or whole vegetables products, however there were some more innovative uses of these ingredients, such as yoghurts and pastas. CONCLUSIONS: Most of the new products currently released onto the Australian market which contain vegetable and legume ingredients do not provide meaningful amounts of these ingredients, and tend to be highly processed and unhealthier options. A multi-faceted approach is needed to improve vegetable and legume consumption, which includes improving the availability of products which help consumers to meet vegetable and legume consumption recommendations. Future research should consider the acceptability of these products to consumers, and the barriers for food manufacturers in creating products with a higher amount of vegetables and legumes.

Nutritional quality of new food products released into the Australian retail food market in 2015 - is the food industry part of the solution?

BACKGROUND: Food manufacturers have made public statements and voluntary commitments, such as the Healthier Australia Commitment (HAC), to improve the nutritional quality of foods. However, limited information about the nutritional quality or healthfulness of new products makes it difficult to determine if manufacturers are doing this. The purpose of this study was to assess the healthfulness of new food products released into the Australian retail market in 2015, and whether those companies who were HAC members released healthier food options compared to non-HAC members. METHODS: This cross-sectional study assessed the healthfulness of all new retail food products launched in Australia in 2015 as indexed in Mintel's Global New Products Database. Healthfulness was assessed using three classification schemes: Healthy Choices Framework Victoria, Australian Dietary Guidelines and NOVA Food Classification System. Descriptive statistics and chi-squared tests described and compared the number and proportions of new foods falling within each of the food classification schemes' categories for companies that were and were not HAC members. RESULTS: In 2015, 4143 new food products were launched into the Australian market. The majority of new products were classified in each schemes' least healthy category (i.e. red, discretionary and ultra-processed). Fruits and vegetables represented just 3% of new products. HAC members launched a significantly greater proportion of foods classified as red (59% vs 51% for members and non-members, respectively) discretionary (79% vs 61%), and ultra-processed (94% vs 81%), and significantly fewer were classified as green (8% vs 15%), core foods (18% vs 36%) and minimally processed (0% vs 6%) (all p < 0.001). CONCLUSIONS: This study found that the majority of new products released into the Australian retail food market in 2015 were classified in each of three schemes' least healthy categories. A greater proportion of new products launched by companies that publicly committed to improve the nutritional quality of their products were unhealthy, and a lower proportion were healthy, compared with new products launched by companies that did not so commit. Greater monitoring of industry progress in improving the healthfulness of the food supply may be warranted, with public accountability if the necessary changes are not seen.

Do Nutrient-Based Front-of-Pack Labelling Schemes Support or Undermine Food-Based Dietary Guideline Recommendations? Lessons from the Australian Health Star Rating System.

Food-based Dietary Guidelines (FBDGs) promote healthy dietary patterns. Nutrient-based Front-of-Pack Labelling (NBFOPL) schemes rate the 'healthiness' of individual foods. This study aimed to investigate whether the Australian Health Star Rating (HSR) system aligns with the Australian Dietary Guidelines (ADGs). The Mintel Global New Products Database was searched for every new food product displaying a HSR entering the Australian marketplace from 27 June 2014 (HSR system endorsement) until 30 June 2017. Foods were categorised as either a five food group (FFG) food or 'discretionary' food in accordance with ADG recommendations. Ten percent (1269/12,108) of new food products displayed a HSR, of which 57% were FFG foods. The median number of 'health' stars displayed on discretionary foods (2.5; range: 0.5-5) was significantly lower (p < 0.05) than FFG foods (4.0; range: 0.5-5), although a high frequency of anomalies and overlap in the number of stars across the two food categories was observed, with 56.7% of discretionary foods displaying ≥2.5 stars. The HSR system is undermining the ADG recommendations through facilitating the marketing of discretionary foods. Adjusting the HSR's algorithm might correct certain technical flaws. However, supporting the ADGs requires reform of the HSR's design to demarcate the food source (FFG versus discretionary food) of a nutrient.

Dietary Supplement Use among Australian Adults: Findings from the 2011-2012 National Nutrition and Physical Activity Survey.

(1) Background: Supplement use is prevalent worldwide; however, there are limited studies examining the characteristics of people who take supplements in Australia. This study aimed to investigate the demographics, lifestyle habits and health status of supplement users; (2) Methods: Adults aged >19 years (n = 4895) were included from the 2011-2012 National Nutrition and Physical Activity Survey (NNPAS). A supplement user was defined as anyone who took one or more supplements on either of two 24-h dietary recalls. Poisson regression was used to estimate the prevalence ratio (PR) of supplement use, according to demographics, lifestyle characteristics and health status of participants; (3) Results: Supplement use was reported by 47% of women and 34% of men, and supplement use was higher among older age groups, among those with higher education levels and from areas reflecting the least socioeconomic disadvantaged. An association was found between blood pressure and supplement use; (4) Conclusions: A substantial proportion of Australians take supplements. Further investigation into the social, psychological and economic determinants that motivate the use of supplements is required, to ensure appropriate use of supplements among Australian adults.

Immunological and nutritional factors in elderly people in low-level care and their association with mortality.

BACKGROUND: This study examines associations between markers of nutritional status and lymphocyte subsets and seeks to determine if lymphocyte profile is predictive of survival in elderly Australians residing in aged care facilities. Aged yet still ambulatory subjects (n = 88, 73% female) living in low-level care and requiring minimal assistance were studied for 143 weeks. At baseline when participants were aged (mean ± SD) 86.0 ± 5.9 years, dietary intake was determined by 3-day weighed food record, body composition was assessed by dual energy X-ray absorptiometry (DXA) and a venous blood sample was taken. RESULTS: At baseline assessment, study participants were consuming nutrient-poor diets and most had symptoms of chronic disease. Although overweight, 40% exhibited sarcopenia. Markers of nutritional status did not relate closely to immune cell numbers (absolute or relative), which on average were within the normal range. Men had lower numbers of CD3(+)CD4(+) cells (CD4(+) T cells), a higher proportion of CD3(-) CD16(±) CD56(±) (natural killer (NK) cells) and a higher ratio of NK: CD4(+) T cells than women (all P < 0.05). The main age-related changes evident were decreased T cells, particularly low CD4(+) T cell counts, and increased numbers of CD19(+) (B-cell) and NK cells. During the 143 week duration of follow-up, about one quarter of the study participants died, with death more likely in men than women (P < 0.01). Poor survival was predicted by the presence of decreased numbers of CD4(+) T cells (hazard ratio (HR) 0.919, P < 0.01) and expanded numbers of NK cells (HR 1.085, P < 0.05) in the blood, and therefore the presence of a high NK: CD4(+) T cell ratio (HR 30.521, P < 0.01). CONCLUSIONS: THE NK: CD4(+) T cell ratio may potentially have clinical utility for predicting longevity in elderly populations. Further studies are needed in other elderly populations to confirm this finding.

Poor physical function in elderly women in low-level aged care is related to muscle strength rather than to measures of sarcopenia.

PURPOSE: To determine the prevalence of sarcopenia and investigate relationships among body composition, muscle strength, and physical function in elderly women in low-level aged care. SUBJECTS AND METHODS: Sixty-three ambulatory women (mean age 86 years) participated in this cross-sectional study where body composition was determined by dual energy X-ray absorptiometry (DXA); ankle, knee, and hip strength by the Nicholas Manual Muscle Tester; and physical function by 'timed up and go' (TUG) and walking speed (WS) over 6 meters. Body composition data from a female reference group (n = 62, mean age 29 years) provided cut-off values for defining sarcopenia. RESULTS: Elderly women had higher body mass index (P < 0.001), lower lean mass (P < 0.001), and higher fat mass (P < 0.01) than the young reference group. Only a small proportion (3.2%) had absolute sarcopenia (defined by appendicular skeletal muscle mass/height squared) whereas 37% had relative sarcopenia class II (defined by percentage skeletal muscle mass). Scores for TUG and WS indicated relatively poor physical function, yet these measures were not associated with muscle mass or indices of sarcopenia. In multivariate analysis, only hip abductor strength predicted both TUG and WS (both P = 0.01). CONCLUSION: Hip strength is a more important indicator of physical functioning than lean mass. Measurement of hip strength may therefore be a useful screening tool to detect those at risk of functional decline and requirement for additional care. Further longitudinal studies with a range of other strength measures are warranted.